Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.
Laboratory of Human Movement Analysis, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager, Hvidovre, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2022 Oct;30(10):3579-3587. doi: 10.1007/s00167-022-06874-y. Epub 2022 Mar 2.
The aim of the present study was to evaluate Achilles tendon length after non-surgical treatment of acute Achilles tendon rupture (aATR), and to evaluate indirect effects of possible persistent elongation on kinematics.
The study was performed as a cross-sectional study based on a population of patients from an RCT regarding non-operative treatment of aATR. Thirty-seven patients out of the 56 in the original RCT participated with at a follow up of 4-5 years after aATR. Primary outcome was Achilles tendon elongation. Additional outcomes were Achilles tendon resting angle (ATRA), calf circumference, passive ankle plantar and dorsiflexion and loading pattern. Foot pressure mapping was performed to measure plantar loading distribution pattern; medial and lateral forefoot peak pressure, heel peak pressure, medial versus lateral loading pattern and timing of heel lift during roll over process. The healthy leg was used as a control.
The injured Achilles tendon was significantly elongated by 1.7 (SD 1.6) cm compared to the non-injured leg. A slight delay of 2.6% (SD 6.0) was measured in heel lift in the injured side compared to the non-injured leg. We found no significant difference in forefoot peak pressure, medial and lateral peak pressure as well as heel peak pressure, and no correlation was found between Achilles tendon length and pressure measurements. Finally, dorsiflexion was 1.9°(SD1.28) larger, ATRA 8.1°(SD6.7) larger, and calf circumference 1.6 cm (SD1.1) lower on the injured leg.
The Achilles tendon was 1.7 cm elongated 4.5 years after the initial injury and significant changes in ATRA, calf circumference and passive dorsiflexion was present. Except for a slight delay in heel lift-off, kinematics during walking was symmetrical between injured and healthy leg, even with an elongated tendon on the injured leg. The clinical relevance of the Achilles tendon elongation is uncertain.
II.
NCT02760784.
本研究旨在评估急性跟腱断裂（aATR）非手术治疗后的跟腱长度，并评估可能持续伸长对运动学的间接影响。
本研究基于一项关于非手术治疗 aATR 的 RCT 人群，采用横断面研究。原始 RCT 中的 56 例患者中有 37 例在 aATR 后 4-5 年随访时参加了研究。主要结局是跟腱伸长。次要结局是跟腱静息角度（ATRA）、小腿围、被动踝关节跖屈和背屈以及负荷模式。足底压力映射用于测量足底负荷分布模式；内侧和外侧前足峰值压力、跟骨峰值压力、内侧与外侧负荷模式以及在滚过过程中脚跟抬起的时间。健康侧用作对照。
与健侧相比，患侧跟腱明显伸长 1.7cm（标准差 1.6cm）。患侧脚跟抬起时间比健侧延迟 2.6%（标准差 6.0%）。我们发现前足峰值压力、内侧和外侧峰值压力以及跟骨峰值压力无显著差异，跟腱长度与压力测量值之间也无相关性。最后，患侧背屈角度大 1.9°（标准差 1.28°），ATRA 大 8.1°（标准差 6.7°），小腿围小 1.6cm（标准差 1.1cm）。
初次受伤后 4.5 年，跟腱伸长 1.7cm，ATRA、小腿围和被动背屈明显变化。除了脚跟抬起时间稍有延迟外，患侧和健侧在行走时的运动学是对称的，即使患侧跟腱伸长。跟腱伸长的临床意义尚不确定。
II 级。
NCT02760784。
